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      Are Dutch adults equally susceptible to nudging and pricing strategies? Secondary analyses of the Supreme Nudge parallel cluster-randomised controlled supermarket trial

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          Abstract

          Background

          Supermarket interventions are promising to promote healthier dietary patterns, but not all individuals may be equally susceptible. We explored whether the effectiveness of nudging and pricing strategies on diet quality differs by psychological and grocery shopping characteristics.

          Methods

          We used data of the 12-month Supreme Nudge parallel cluster-randomised controlled supermarket trial, testing nudging and pricing strategies to promote healthier diets. Participants were Dutch speaking adults aged 30–80 years and regular shoppers of participating supermarkets ( n = 12) in socially disadvantaged neighbourhoods. Data on psychological characteristics (food-related behaviours; price sensitivity; food decision styles; social cognitive factors; self-control) and grocery shopping characteristics (time spent in the supermarket; moment of the day; average supermarket visits; shopping at other retailers; supermarket proximity) were self-reported at baseline. These characteristics were tested for their moderating effects of the intervention on diet quality (scored 0–150) in linear mixed models.

          Results

          We included 162 participants from intervention supermarkets and 199 from control supermarkets (73% female, 58 (± 10.8) years old, 42% highly educated). The interventions had no overall effect on diet quality. Only five out of 23 potential moderators were statistically significant. Yet, stratified analyses of these significant moderators showed no significant effects on diet quality for one of the subgroups and statistically non-significant negative effects for the other. Negative effects were suggested for individuals with lower baseline levels of meal planning ( β − 2.6, 95% CI − 5.9; 0.8), healthy shopping convenience ( β − 3.0, 95% CI − 7.2; 1.3), and healthy food attractiveness ( β − 3.5, 95% CI − 8.3; 1.3), and with higher levels of price consciousness ( β − 2.6, 95% CI − 6.2; 1.0) and weekly supermarket visits ( β − 2.4, 95% CI − 6.8; 1.9).

          Conclusions

          Adults with varying psychological and grocery shopping characteristics largely seem equally (un)susceptible to nudging and pricing strategies. It might be that certain characteristics lead to adverse effects, but this is not plausible, and the observed negative effects were small and statistically non-significant and may be explained by chance findings. Verification of these findings is needed in real-world trials based on larger sample sizes and with the use of more comprehensive interventions.

          Trial registration

          Dutch Trial Register ID NL7064, 30th of May, 2018, https://onderzoekmetmensen.nl/en/trial/20990

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12916-024-03429-5.

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          Most cited references50

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          Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019

          Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost all countries outside high-income countries, and alarmingly, the age-standardized rate of CVD has begun to rise in some locations where it was previously declining in high-income countries. There is an urgent need to focus on implementing existing cost-effective policies and interventions if the world is to meet the targets for Sustainable Development Goal 3 and achieve a 30% reduction in premature mortality due to noncommunicable diseases.
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            Multiplicity of data, hypotheses, and analyses is a common problem in biomedical and epidemiological research. Multiple testing theory provides a framework for defining and controlling appropriate error rates in order to protect against wrong conclusions. However, the corresponding multiple test procedures are underutilized in biomedical and epidemiological research. In this article, the existing multiple test procedures are summarized for the most important multiplicity situations. It is emphasized that adjustments for multiple testing are required in confirmatory studies whenever results from multiple tests have to be combined in one final conclusion and decision. In case of multiple significance tests a note on the error rate that will be controlled for is desirable.
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              This article reviews a diverse set of proposals for dual processing in higher cognition within largely disconnected literatures in cognitive and social psychology. All these theories have in common the distinction between cognitive processes that are fast, automatic, and unconscious and those that are slow, deliberative, and conscious. A number of authors have recently suggested that there may be two architecturally (and evolutionarily) distinct cognitive systems underlying these dual-process accounts. However, it emerges that (a) there are multiple kinds of implicit processes described by different theorists and (b) not all of the proposed attributes of the two kinds of processing can be sensibly mapped on to two systems as currently conceived. It is suggested that while some dual-process theories are concerned with parallel competing processes involving explicit and implicit knowledge systems, others are concerned with the influence of preconscious processes that contextualize and shape deliberative reasoning and decision-making.
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                Author and article information

                Contributors
                j.stuber@amsterdamumc.nl
                Journal
                BMC Med
                BMC Med
                BMC Medicine
                BioMed Central (London )
                1741-7015
                10 June 2024
                10 June 2024
                2024
                : 22
                : 228
                Affiliations
                [1 ]GRID grid.12380.38, ISNI 0000 0004 1754 9227, Epidemiology and Data Science, , Amsterdam UMC Location Vrije Universiteit Amsterdam, ; De Boelelaan 1117, Amsterdam, The Netherlands
                [2 ]GRID grid.16872.3a, ISNI 0000 0004 0435 165X, Amsterdam Public Health, ; Amsterdam, The Netherlands
                [3 ]GRID grid.12380.38, ISNI 0000 0004 1754 9227, Upstream Team, www.upstreamteam.nl, Amsterdam UMC Location Vrije Universiteit Amsterdam, ; De Boelelaan 1117, Amsterdam, Netherlands
                [4 ]GRID grid.5477.1, ISNI 0000000120346234, Julius Center for Health Sciences and Primary Care, , University Medical Center Utrecht, Utrecht University, ; Universiteitsweg 100, Utrecht, The Netherlands
                Article
                3429
                10.1186/s12916-024-03429-5
                11163734
                38853270
                b5ef28db-8de0-4b1d-a4e2-d87192685f21
                © The Author(s) 2024

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 7 March 2024
                : 16 May 2024
                Categories
                Research
                Custom metadata
                © BioMed Central Ltd., part of Springer Nature 2024

                Medicine
                prevention,food environment,choice architecture,public health nutrition,grocery store
                Medicine
                prevention, food environment, choice architecture, public health nutrition, grocery store

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